A snapshot of the adult spina bifida patient – high incidence of urologic procedures

Abstract

IntroductionTo describe the urologic outcomes of contemporary adult spina bifida patients managed in a multidisciplinary clinic.Material and methodsA retrospective chart review of patients seen in our adult spina bifida clinic from January 2004 to November 2011 was performed to identify urologic management, urologic surgeries, and co-morbidities.Results225 patients were identified (57.8% female, 42.2% male). Current median age was 30 years (IQR 27, 36) with a median age at first visit of 25 years (IQR 22, 30). The majority (70.7%) utilized clean intermittent catheterization, and 111 patients (49.3%) were prescribed anticholinergic medications. 65.8% had urodynamics performed at least once, and 56% obtained appropriate upper tract imaging at least every other year while under our care. 101 patients (44.9%) underwent at least one urologic surgical procedure during their lifetime, with a total of 191 procedures being performed, of which stone procedures (n = 51, 26.7%) were the most common. Other common procedures included continence procedures (n = 35, 18.3%) and augmentation cystoplasty (n = 29, 15.2%). Only 3.6% had a documented diagnosis of chronic kidney disease and 0.9% with end-stage renal disease.ConclusionsMost adult spina bifida patient continue on anticholinergic medications and clean intermittent catheterization. A large percentage of patients required urologic procedures in adulthood. Patients should be encouraged to utilize conservative and effective bladder management strategies to reduce their risk of renal compromise.

Ambulatory Care Use among Patients with Spina Bifida: Change in Care from Childhood to Adulthood

“…14 Other studies have also reported a higher proportion of females in adult SB clinics, although to a lesser degree than seen in this study. 5,15,16 The greater difference seen in this cohort may be due to the lack of a transitional care process, which may disproportionally effect men. This could indicate a need to more intentionally keep men engaged in their medical care during the transitional process and in adulthood.…”

“…Consistent care in the outpatient setting is thought to help these patients stay healthy and avoid potentially preventable adverse outcomes that require hospitalizations, surgeries, or emergency department visits. 2–5 Age-appropriate care can also help patients achieve their fullest potential as adults. 6 However, it is well-known that transitioning patients from the pediatric to adult setting can be problematic, with many patients never transitioning and others becoming lost to follow-up altogether.…”

“…Since the aging SB patient is a relatively new phenomenon, these changes remain poorly defined. While there are reports on how patterns of inpatient admissions, emergency department visits, and surgical utilization of these patients change as they age, 2,4,5,11,12 an understanding of their outpatient care utilization is lacking. Additionally, the utilization of patients who do not transition may be different from those who do, but these differences remain unclear.…”

The Utility of Urodynamic Studies in Neuro-Urological Patients

“…Given the fact that UDS is the only method for objectively assessing any abnormalities of the LUT, this technique remains underutilized. Some studies have shown that a large proportion of patients presenting with NLUTD never underwent UDS investigation in the course of their management [ 56 , 57 ]. When referred, these patients’ initial management consisted of a focused history and clinical evaluation combined with a urinalysis and PVR measurement.…”

Urodynamic Techniques in Clinical Practice as the "Gold Standard" for Examining Children with Urinary Disorders (A Lecture)

“…Вельтищева отмечено, что первичная диагностика нарушений мочеиспускания проводилась менее чем в 10% случаев, при этом длительность заболевания составляла более 12 месяцев. Анализ литературы также показал, что современные методы диагностики нарушений мочеиспускания, например, клиническое уродинамическое исследование (КУДИ), не использовались у пациентов с нейрогенным мочевым пузырем в ходе наблюдения и лечения, хотя КУДИ является «золотым стандартом» диагностики для категоризации нейрогенных расстройств мочеиспускания, в том числе и у детей раннего возраста [13][14][15].…”